None of the four trusts now eligible for foundation status has yet decided whether to go-it-alone despite strong encouragement from Mr Blair.

The trusts - Liverpool Women's Hospital, Alder Hey, Wirral Hospital and the Clatterbridge Centre for Oncology - all scored a maximum three stars in NHS league tables earlier this month.

In moving to foundation status they would gain the freedom to set their own pay levels and borrow money for improvements.

But none have yet committed themselves to taking the step, insisting they needed to consult staff and others before taking what was described as a "big decision".

Their caution suggests many hospitals will not easily be convinced of the benefit of foundation status, which the government considers crucial to its attempts to improve the NHS.

Wirral Hospital rejected its first opportunity to become a "super-hospital", arguing it would "distract" the trust from more important issues for both staff and patients.

It means the Countess of Chester is the only local hospital definitely pressing ahead with a bid for the new financial freedoms, with a decision expected in December.

The four Merseyside trusts are among 38 in England which the government wants to turn into foundation hospitals as a "second wave", in either autumn 2004 or spring 2005.

Health Minister John Hutton announced yesterday that he was writing to the chief executives of each trust, urging them to put in applications this autumn.

He said: "I have little doubt that many of these trusts will see their three-star status as something to build upon and will clearly want to consider whether foundation trust status is right for them."

But Suzanne Hughes, a spokeswoman for Alder Hey, said the trust was still "considering options", and was holding talks with staff today .

She said: "We have not yet decided whether to take up the invitation. It is a big decision and we want to closely involve our staff in making that decision."

Frank Burns, Wirral Hospital's chief executive, said: "We have not ruled out an application at a later date when circumstances allow."

A spokeswoman for the Liverpool Women's Hospital said a consultation document would be put forward at a board meeting in September, with a decision some way off.

While the Clatterbridge Centre said it would not consider whether to apply until its new chief executive, Tony Halsall, took up his post in September. Applications will be assessed on responsiveness to patients, clinical standards, leadership and management, commitment and support of staff, partnership working and financial performance.

The Health and Social Care Bill, which will set up the foundation trusts, has cleared the House of Commons, but is expected to receive a rough ride in the Lords in October.